Track topics on Twitter Track topics that are important to you
Dexamethasone has been reported to reduce postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy (LC). However, its effects on other surgical outcomes such as pain and fatigue have been unclear. We evaluated the efficacy of preoperative dexamethasone in ameliorating postoperative symptoms after LC.
Methods: Prospective, double-blind, placebo-controlled study, 210 patients scheduled for elective LC were analyzed after randomization to intravenous dexamethasone (8 mg) or to a placebo. All patients underwent standardized procedures for general anesthesia and surgery. Episodes of PONV and pain and fatigue scores were recorded on a visual analogue scale. Analgesic and antiemetic requirements were also recorded.
Patients and methods
Patients Between January 2007 and August 2008, 210 patients undergoing LC were studied in accordance with a prospective, randomized, double-blind clinical trial. Patients were randomized to receive intravenous dexamethasone (8 mg) or homologated placebo 60 minutes before skin incisions, using an equal number of blind envelopes. Patients of American Society of Anesthesiologists (ASA) classes III and IV were excluded. Further exclusion criteria were age more than 80 years; pregnancy; treatment with steroids; severe diabetes mellitus (HbA1c > 8%); use of opioids, sedatives or any kind of analgesics less than one week before LC; a history of alcohol or drug abuse; preoperative diagnosis of acute cholecystitis, acute pancreatitis, choledocolithiasis, gallbladder carcinoma and/or conversion of the LC to an open procedure. All patients were followed from hospital admission until 30 days after the surgical procedure.
Anesthesia and surgery All patients underwent a standardized general anesthesia procedure. Induction used intravenous midazolam (1.5 mg) and fentanyl (3-5 mcg/kg of body weight) and propofol (2 mg/kg body weight). Anesthesia was maintained with 2 to 3% sevoflurane and 100% oxygen concentration. Neuromuscular blocking was maintained with intravenous vecuronium (0.1 mg/kg body weight). All patients were monitored with indirect determinations of arterial pressure and heart rate using the standard technique as well as expired CO2 content and oxygen blood saturation. A nasogastric tube was placed in all patients during the operation and taken out at the end of the surgical procedure. Afterwards, all patients were extubated and transferred to the immediate postsurgical care unit with cardiovascular and oxygen monitoring.
All patients received preoperative intravenous antibiotics (1 g of intravenous first-generation cephalosporin). LC was performed using a 2-handed, 4-trocar technique with 2 10-mm ports and 2 5-mm ports. A 10-mm subumbilical port was introduced by the open method, subsequently creating a pneumoperitoneum, maintained at 12 to 14 mmHg of intra-abdominal pressure. All of the laparoscopic treatments were performed by expert surgeons, each having sufficient experience of laparoscopic surgery (more than 150 LCs per year). The skin was closed with single nonabsorbable sutures. Closed suction drains were placed in the inferior surface of the liver, using a 5-mm lateral port in some patients according to each surgeon's preference. The drains were removed during the following 12-24 h.
Analgesia and antiemetics Pain and fatigue were assessed preoperatively and immediately on return to the recovery room, and at 6, 12 and 24 h after the operation using a visual analogue scale (VAS; 0 = no pain/fatigue to 10 = most severe pain/fatigue) [7,15,16]. Analgesia was given as intravenous sodium ketorolac (30 mg every 8 h). Intramuscular buprenorphine (0.15-0.30 mcg) was used as a backup analgesic medication. The incidence of PONV was recorded immediately on return to the recovery room and at 6, 12 and 24 h, after the operation, using a four-point ordinal scale (0 = none, 1 = nausea, 2 = nausea with request for antiemetic, 3 = vomiting). Intravenous ondansetron (4-8 mg) was given for antiemetic treatment on demand.
Data collection and statistical analysis Postoperative complications were recorded during hospitalization and the patients were followed up to 30 days after discharge. Data collected also included patient age, sex, body mass index (BMI), ASA score, history of previous abdominal surgery, anesthesia and operation time and frequency of use of analgesic and antiemetic drugs. These parameters were summed and compared between the dexamethasone and placebo groups. The study endpoints were degree of postoperative nausea, vomiting, pain and fatigue and additional analgesic and antiemetic drugs.
The sample size was predetermined. We expected a 20% difference in the incidence of nausea and vomiting between groups. The error alpha error was set at 0.05 and beta error at 0.20; n = 103 patients for each group was considered adequate, according to a power analysis. Results were expressed as percentages and as the mean ± standard deviation (SD). Student's t test and the chi squared test were used for the analysis of quantitative and qualitative data, respectively. Differences were considered statistically significant at p < 0.05.
Ethical considerations The study was conducted according to the principles of the Declaration of Helsinki of 1989 and the Mexican Health Guidelines. The Ethical and Research Committees of the Regional Hospital # 110 of the Mexican Institute for Social Security in Jalisco, Mexico approved all protocols. Full, written informed consent was obtained from all patients before their inclusion in the study.
Allocation: Randomized, Control: Placebo Control, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Prevention
Postoperative Nausea and Vomiting
Department of Surgery and Department od Anesthesiology. Specialties Hospital. Westerm Medical Center, Mexican Institute of Socia
Instituto Mexicano del Seguro Social
Published on BioPortfolio: 2014-08-27T03:17:19-0400
Postoperative nausea and vomiting (PONV) are the most common and distressing side effects following Laparoscopic cholecystectomy
Adeno-tonsillectomy is a commonly performed surgical procedure in children.Main morbidities are postoperative pain, nausea and vomiting, and haemorrhage.Non-steroidal anti-inflammatory dru...
The combination of aprepitant and lower dose dexamethasone is superior to aprepitant alone with respect to the proportion of patients with a complete response (no vomiting and no use of re...
Effect of intravenous versus intra-peritoneal dexamethasone on the incidence of postoperative nausea and vomiting following Laparoscopic gynecological surgeries.
Background: Dexamethasone is a steroid, which is often given into the vein before chemotherapy to help control acute nausea and vomiting. It can also be given as an oral tablet for patient...
Postoperative nausea and vomiting causes distress for patients and can prolong care requirements. Consensus guidelines recommend use of multiple antiemetics from different mechanistic classes as proph...
The approach to the treatment of nausea and vomiting in a cancer patient should begin with a complete assessment, including the frequency, duration, and intensity of the nausea/vomiting; associated ac...
Postoperative nausea and vomiting (PONV) is a common, unpleasant phenomenon and current therapies are not always effective for all patients. Aromatherapy has been suggested as an addition to the avail...
Doxylamine-pyridoxine is recommended as a first line treatment for nausea and vomiting during pregnancy and it is commonly prescribed. We re-analysed the findings of a previously reported superiority ...
The purpose of this study was to investigate effect of cerebral oxygen saturation (SCTO2) on postoperative nausea and vomiting (PONV) in female patients who underwent laparoscopic surgery.
Emesis and queasiness occurring after anesthesia.
Abdominal symptoms after removal of the GALLBLADDER. The common postoperative symptoms are often the same as those present before the operation, such as COLIC, bloating, NAUSEA, and VOMITING. There is pain on palpation of the right upper quadrant and sometimes JAUNDICE. The term is often used, inaccurately, to describe such postoperative symptoms not due to gallbladder removal.
Drugs used to prevent NAUSEA or VOMITING. Antiemetics act by a wide range of mechanisms. Some act on the medullary control centers (the vomiting center and the chemoreceptive trigger zone) while others affect the peripheral receptors.
Symptoms of NAUSEA and VOMITING in pregnant women that usually occur in the morning during the first 2 to 3 months of PREGNANCY. Severe persistent vomiting during pregnancy is called HYPEREMESIS GRAVIDARUM.
A histamine H1 antagonist given by mouth or parenterally for the control of postoperative and drug-induced vomiting and in motion sickness. (From Martindale, The Extra Pharmacopoeia, 30th ed, p935)
Pain is defined by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage”. Some illnesses can be excruci...
Anesthesia is the loss of feeling or sensation in all or part of the body. It may result from damage to nerves or can be induced by an anesthetist (a medical professional) using anesthetics such as thiopental or propofol or sevoflurane during a surgical ...